Moving Beyond Pain
Targeted Exercise Helps You Control Debilitating Conditions
Marjorie Ryan was one visit away from getting a spinal cord stimulator implanted in her spine to control her pain from failed back surgery. She used to get about nine months of relief from epidural injections. But when those injections and multiple medications failed to alleviate her pain, she faced the prospect of an implantable pacemaker. Before she took that step, however, she began a physical therapy program, which reduced her pain from 10 to 3 on a scale of 1 to 10.
"The power of exercise is so important to your life," she says. "It has to be a constant commitment to keep living well and strong."
As Ryan's story shows, exercise is potent medicine. The correct exercise program will cure high blood pressure in 75 percent of people on medication and, with weight loss, will cure type 2 diabetes. Exercise is also one of the most effective tools to treat pain. It keeps arthritic joints from hurting; controls low back pain; and, by preventing osteoporosis, avoids the pain of an osteoporotic spine or hip fracture.
But not all physical activity is created equal. Exercise to treat heart disease and hypertension is very different from that to treat arthritis. As always, consult your doctor before beginning an exercise regimen.
More people suffer from back pain than have heart disease, diabetes, and cancer combined. It costs our country more than $100 billion a year in medical expenses and lost productivity. Obviously, this is a very serious problem. But if you know what to do and how to get started, you will learn, like Ryan, that you have the power to control your disease. The most important thing you must remember is that you have to get moving.
Our natural response to pain is to stop doing what hurts. And that means we stop moving or move in abnormal ways that protect the painful area. When you decrease your activity level in an attempt to control pain, your muscles weaken quickly, spasm, and are no longer able to support your aching spine, which only makes your pain that much worse. In this case, pain is not a signal of tissue damage, but rather your pain pathways screaming out of control. Most pain flare-ups, although scary, don't signal a worsening of your condition. But there are signs that concern doctors and should be evaluated quickly. If you experience new acute pain running down your leg, if your leg pain is accompanied by new or worsening numbness or weakness, or you have loss of bowel or bladder function, consult your doctor.
For the majority of low-back pain sufferers, simply moving is more important than exercise per se. Start with gentle stretching and walking as tolerated. When the level of pain is under control, you can begin a more regular walking program. Start with 10 minutes of gentle walking. Then pick up the pace. Walking at a brisk pace for even 10 minutes a day improves heart health, aids aerobic conditioning, and controls pain. Slowly increase the amount of time you walk to 20 to 30 minutes three to five days a week.
Most important is to walk, move, and even sit with your core (abdomen and back muscles) engaged. Tighten your stomach as if you are bracing for a punch in the gut — and hold it. Now you have the deepest sets of abdominal muscles working. A strong core that you use all day, every day, is your best treatment and prevention for flare-ups of low-back pain. When you lift, bend, or sit at a computer, engage your abdominal muscles.
And don't forget to practice balance. For example, brush your teeth standing on one leg or put your shoes and socks on while standing.
Exercise not only eases pain in people suffering from arthritis, but also it can prevent the development of joint pain by keeping the muscles supporting each joint in top condition. Although 90 percent of people older than 40 have arthritic changes in their joints, the ones who become crippled with pain are the ones with weak muscles that can no longer provide support and stability for those joints. The stronger the muscles, the more work they can do and the less wear and tear on your hips, knees, and even shoulders. You especially need to exercise once joints start to hurt to keep the pain from worsening.
For many medical conditions, walking is the best exercise, but it's pointless to start a walking program when the muscles supporting your arthritic hips or knees are too weak to support those joints. You will only make the pain worse. Instead, start with flexibility exercises. After a week or two, start weight training under the supervision of a good physical therapist. The best program involves overall strengthening with special focus on the muscles supporting your aching joints. As you build strength, you will be better able to tackle the last part of your exercise program: aerobics. Because of its repetitive nature, aerobic (cardio) exercise can aggravate arthritic joints. But after you are strong, walking becomes very important for heart health and weight control. And there's nothing better for aching joints than warm pool water to increase strength and mobility.
Try this regimen: Warm up for 10 minutes. Include stretches specific for your painful joints. Then proceed to weight training, again with special focus on arthritic areas. You should use heavier weights with fewer repetitions to maximize muscle building and minimize joint stress. Then add aerobic exercise for 10 minutes three days a week. Eventually progress to 30 to 40 minutes three days a week. You should be exercising hard enough to break a sweat, but not so hard that you can't carry on a conversation or sing to yourself. Finish your session with a 10-minute cool down that again focuses on joint-specific stretching.
When you are done, ice your joints for 10 to 20 minutes to control inflammation, which is what causes the pain.
Over 1.3 million fractures occur every year due to osteoporosis. An inactive lifestyle leads to brittle bones. Exercise prevents bone loss and can even reverse it after it starts.
Unlike chronic pain, where your major focus is to simply get moving, your focus here needs to be on weight-bearing activities like walking or jogging. These are impact exercises. Your bones respond to exercise just like your muscles; the stress (impact) makes them stronger. Swimming and water aerobics do not provide the impact stimulus your bones need to get strong; so if your exercise time is limited, pick dancing or hiking instead.
After a 10-minute warm-up, pick your impact activity of choice. Your impact cardio session should start at 10 minutes and progress to 30 to 40 minutes three to four days a week, with another 10 minutes for cool down. And don't forget to lift weights. The force of your muscles pulling against your bones also stresses them to get strong. You want to use weights heavy enough so that your muscles are working hard; you should wear out after about 12 to 15 repetitions of each exercise.
TIPS FOR EVERY DAY
• Do not use your arms to help you get out of a chair; use your legs.
• Do deep knee bends while you are waiting for the coffee to brew.
• Keep your shoulders back to control shoulder pain and prevent dowager's hump.
• Carry bags of groceries into the house in one hand. An unbalanced load will strengthen your core.
• Subtly stand on one leg in the checkout line to practice balance.
So now you're ready to start exercising, but that is just 30 minutes of your day. How you spend the other 23 1/2 hours is equally important. Even patients who exercise regularly may complain of weakness, fatigue, and balance problems because we unconsciously move less the older we get. When was the last time you skipped down the hall like you did when you were a child?
Be aware of how you move (or don't) throughout the day. Do anything that adds a bit of calorie burning and movement. Instead of just sitting in front of the television, use the time to stretch or play catch with the dog. (Research has shown that even sitting reading a book burns more calories than sitting in front of the TV screen.) Find simple ways to get moving. You have the power to control your life and your health.
Ruth Anderson is board certified in anesthesiology and pain management, has a master's degree in exercise physiology, and is the author of Get Moving! Live Better, Live Longer.
Photography by Scott Avra